Credentialing Administrator

Pediatrics Plus; Conway (AR); Hybrid; USD 48,000 - 64,000; Full time

Benefits offered by this job

PTO 15 days

Competitive pay

Discounts & incentives

Professional development

State-of-the-art facilities

Job summary

Pediatrics Plus is seeking a Credentialing Administrator to manage and maintain provider credentialing with contracted insurers, ensuring enrollment and eligibility for reimbursement. You will oversee the process from application through ongoing maintenance, ensuring payer compliance and smooth billing operations.

Responsibilities include updating CAQH, coordinating with RehabNet, and maintaining provider documents and licenses while protecting confidentiality across a busy practice.

Qualifications

• Effective communication with diverse people.
• Strong organizational skills with attention to detail.
• Proficient computer skills including databases, word processing, and spreadsheets.
• Ability to manage multiple tasks in a busy environment.
• Ability to read and interpret documents and write routine reports.

Responsibilities

• Maintain credentialing and recredentialing of all team members.
• Utilize the HR database and improve efficiency.
• Maintain provider data in HCM and deTASO.
• Update CAQH online credentialing for all providers quarterly.
• Coordinate credentialing with RehabNet for all insurances.

Skills

Communication skills

Organizational skills

Computer skills

Multitasking

Reading and writing

Education

High School Diploma

Tools

Databases

Word processing

Spreadsheets

Internet software

Job description

We are currently seeking a Credentialing Administrator to join our team of highly qualified professionals that share our mission of Empowering Children to Conquer their World! This role is responsible for responsible for managing and maintaining provider credentialing with all contracted insurance carriers to ensure providers are properly enrolled and eligible for reimbursement. The Credentialing Administrator will oversee the credentialing process from initial application through ongoing maintenance and recredentialing, ensuring compliance with payer requirements, all applicable laws and regulations, and organizational policies minimizing disruptions to billing and revenue cycle operations.

What we offer:

• Competitive Pay
• 15 Days of Paid Time Off
• Company Discounts & Incentives
• Professional Development and Leadership Growth Opportunities
• State of the Art Facilities & Technology

What you will do:

• Maintain credentialing and recredentialing of all Therapy, Developmental Preschool, Management, and RISE team members.
• Implement and utilize the HR database, including ways to improve efficiency by use of the database.
• Compile and maintain current and accurate data for all providers in HCM and deTASO.
• Maintain and update Council for Affordable Quality Healthcare (CAQH) online credentialing application for all providers quarterly.
• Coordinate credentialing with RehabNet for all insurances they cover.
• Monitor expirations of providers' (RBTs and BCBAs) CPR certification for Tricare.
• Complete provider credentialing and recredentialing applications; monitor applications and follow-up as needed.
• Maintain documentation and reporting regarding provider enrollments in process.
• Maintain copies of malpractice coverage, current state licenses, and any other required credentialing documents for all providers.
• Maintain updated roster of providers for Professional Liability Insurance.
• Notify applicable insurance companies of provider terminations.
• Track license and certification expirations for all providers to ensure timely renewals and updates health plans accordingly.
• Ensure practice addresses are current with health plans.
• Maintain confidentiality of provider information.
• Update job knowledge by some or all of the following: participating in educational opportunities; reading professional publications; maintaining personal networks and/or participating in professional networks.

What you have:

• Ability to communicate effectively and professionally with a wide variety of people.
• Strong organizational skills with attention to detail and accuracy.
• Computer skills which include a working knowledge of databases, word processing, spreadsheets, and internet software.
• Ability to handle multiple tasks in a very busy environment.
• Ability to read and interpret documents such as safety rules, policies, and other company documents.
• Ability to write routine reports and correspondence.
• Ability to effectively present information in one-on-one and small group situations.
• Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form.
• Reports for work dressed appropriately and complies with company policies regarding the dress code.
• Ability to maintain regular and punctual attendance.
• Ability to complete tasks in a timely manner.

Required Qualifications:

• High School Diploma or equivalent.

Physical Demands:

While performing the duties of this job, the employee is frequently required to accurately communicate information and ideas so others will understand through sight and hearing. The employee is regularly required to move including walking, running, jumping, and sitting. The employee is regularly required to use hands and fingers to handle, lift, reach, and feel. The employee is frequently required to stand and stoop, twist, bend, kneel, crouch, or crawl. The employee must frequently lift and/or move up to 50 pounds. Specific vision abilities required by this job include near and distance vision, color vision, peripheral vision, depth perception, and ability to adjust focus.

We are an equal opportunity employer and prohibit discrimination/harassment without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.